CHAPTER 1

INTRODUCTION

1.1 CIRRHOSIS
1.2 ASCITIES
1.3 PEPTIC ULCER DISEASE

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1. GENERAL INTRODUCTION
In Various Gastro Intestinal & hepatic diseases rationalization of pharmacotherapy is intended to
maximize the effectiveness, minimize the risks and costs and to respect patient wishes. It
comprises of major five components that are defensible formulation of patient’s problem, clarity
of therapeutic intention, access to independent data on drugs, communication with the patient
and Follow up.
The main Criteria used for rational pharmacotherapy is:
• Appropriate indication
• Appropriate drug
• Appropriate patient
• Appropriate information
• Appropriate monitoring

Gastro intestinal disease comprises the impairment of gastro intestinal (GI) system The GI tract
is composed of organs and tissues that have diverse forms and functions. It includes the
esophagus, stomach, small intestine, large intestine, colon, rectum, biliary tract, gallbladder,
liver, and pancreas. GI & hepatic disorders may be classified into gastroesophageal reflux
disease, inflammatory bowel disease, peptic ulcer disease, diarrhoea, constipation, irritable
bowel syndrome, cirrhosis, hepatitis, ascites and pancreatitis.

Among These main GI disorders 7 hepatic disorders three diseases have been considered for
rationalization of pharmacotherapy in this project. These diseases Cirrhosis, ascites and peptic
ulcer disease have been selected based on the high prevalence ratio in gastroenterology ward,
Hayyatabad medical complex. Cirrhosis because of HCV and HBV are the predominant
complication of this geographical area where as peptic ulcer disease because of H Pylori is
epidemic and cirrhotic ascites (accommodation of fluid in peritoneal cavity) have high
prevalence ratio as compared to malignant ascites.

Further, Rationalization of pharmacotherapy in these mentioned diseases were identified &

evaluated regarding the extent to which standard recommended pharmacotherapy regime for
respective disease has been followed in our health care system. The frequency and types of drug-
related problems (DRPs), risk factors for DRPs and the drugs most frequently causing them were
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noted. Emphasis should be done for developing strategies to improve DRPs identification and
management skills for the improvement of patient’s response towards pharmacotherapy.